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Psychiatry > Pharmacology of Antidepressants and Mood Stabilisers > Flashcards

Pharmacology of Antidepressants and Mood Stabilisers Flashcards

1
Q

What are the clinical uses of antidepressants?

A
  • Moderate to severe depression
  • Dysthymia
  • Generalised anxiety disorder
  • Panic disorder, OCD, PTSD
  • Premenstrual dysphoric disorder
  • Bulimia nervosa
  • Neuropathic pain
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2
Q

Name 3 groups of antidepressant drugs.

A
  • Monoamine oxidase inhibitors.
  • Monoamine reuptake inhibitors.
  • Atypical drugs (post-synaptic receptor effects).
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3
Q

Give 3 subgroups of monoamine reuptake inhibitors.

A
  • Tricyclics.
  • Other non-selective reuptake inhibitors.
  • Selective serotonin reuptake inhibitors.
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4
Q

SSRI’s belong to what group?

A

Monoamine reuptake inhibitors

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5
Q

How many amine groups do monoamines have?

A

1 lol obvs

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6
Q

How do most antidepressants work?

A

By altering monoamine neurotransmission in some way

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7
Q

What does depression result from?

A

A functional problem in the monoamine transmitters

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8
Q

Name 3 main monoamine transmitters.

A
  • Serotonin (5-HT)
  • Noradrenaline
  • Dopamine
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9
Q

What do drugs that deplete stores of monoamines do?

A

Cause a low mood

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10
Q

CSF from depressed patients have reduced levels of monoamines or metabolites

A

TRUE

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11
Q

Most drugs that treat depression act to ________ monoaminergic transmission

A

INCREASE

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12
Q

What is the life cycle of serotonin?

A
  1. Tryptophan is in the presynaptic cleft
  2. It is converted to 5-OH-tryptophan by tryptophan hydroxyls (enzyme)
  3. 5-OH-tryptophan is converted to 5-HT by LAA-decarboxylase (enzyme)
  4. 5-HT leaves presynaptic cleft and is taken up by postsynaptic cleft
  5. 5-HT is then re-taken by presynaptic cleft
  6. 5-HT converted to 5-HIAA by MAO’s
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13
Q

What is the life cycle of noradrenaline?

A
  1. Tyrosine in presynaptic cleft
    2 Tyrosine converted to DOPA by tyrosine hydeoxylase (enzyme)
  2. DOPA converted to DA by LAA-decarboxylase (enzyme)
  3. DA converted to NA by DA-beta-hydroxylase (enzyme)
  4. NA leaves presynaptic cleft and is taken up by postsynaptic cleft
  5. NA is then re-taken by presynaptic cleft
  6. NA converted to MHPG by MAO’s
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14
Q

Name 2 MAO inhibitors.

A
  • Phenelzine

* Moclobemide

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15
Q

How to MAO inhibitors work?

A

Inhibit MAO to increase neurotransmitter concentration.

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16
Q

What is the mode of action of MAO inhibitors?

A

Either irreversible or reversible inhibitors of MAO-A and B

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17
Q

Which MAO inhibitor is reversible and what one is irreversible?

A

Irreversible – phenelzine.

Reversible – moclobemide.

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18
Q

What are the main side effects of MAO inhibitors?

A
  • ‘Cheese reaction’/Hypertensive crisis.
  • Potentiates effects of other drugs (ie. barbiturates) by decreasing their metabolism.
  • Insomnia.
  • Postural hypotension.
  • Peripheral oedema.
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19
Q

What is the ‘cheese reaction’/hypertensive crisis caused by?

A

Inhibition of MAO-A in the gut (+ liver) by irreversible inhibitors, preventing breakdown of dietary tyramine, and by multiple drugs that potentiate amine transmission (ie. pseudoephedrine, other anti-depressants).

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20
Q

To prevent hypertensive crisis, what should patients be advised?

A

Don’t eat cheese or gravy :(

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21
Q

How do tricyclic antidepressants work?

A

Block the re-uptake of NT

22
Q

Give 4 examples of TCA’s.

A

Imipramine.
Dosulepin.
Amitriptyline.
Lofepramine.

23
Q

What is the mode of action of TCA’s?

A

Block the reuptake of monoamines (mainly noradrenaline and 5-HT) into presynaptic terminals.

24
Q

What are the common side effects of TCA’s?

A
  • Anticholinergic-
    blurred vision, dry mouth, constipation, urinary retention
  • Sedation
  • Weight gain
  • Cardiovascular-
    Postural hypotension, tachycardia, arrhythmias
  • Cardiotoxic in overdose
25
Q

Give 4 examples of SSRI’s.

A
  • Fluoxetine.
  • Citalopram/Escitalopram.
  • Sertraline.
  • (Paroxetine)
26
Q

What is the mode of action of SSRI’s?

A

Selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft

27
Q

What are the common side effects of SSRI’s?

A
  • Nausea
  • Headache
  • Sweating / vivid dreams
  • Worsened anxiety
  • Sexual dysfunction
  • Hyponatraemia (in elderly)
  • Transient increase in self-harm / suicidal ideation in <25 years
28
Q

Name 2 dual reuptake inhibitors (SNRI’s).

A
  • Venlafaxine

* Duloxetine

29
Q

How do SNRI’s work?

A

Block the reuptake of monoamines (noradrenaline AND 5-HT) into presynaptic terminals

30
Q

What are the side effects of SNRI’s? What is the main advantage to the use of these?

A

S/E’s are similar to SSRI’s

Lack major receptor-blocking actions so fewer side effects than tricyclics

31
Q

Mirtazapine

A

Has mixed receptor affects

32
Q

What does Mirtazapine block?

A

alpha2, 5-HT2 & 5-HT3

33
Q

What are the side effects of a drug like mirtazapine which has mixed receptor effects?

A

Weight gain + sedation

34
Q

What can mirtazapine do if given with SSRI’s?

A

Block serotonergic side-effects.

ie. nausea  5-HT3 antagonists are used as anti-emetics.

35
Q

Name a dopamine uptake inhibitor.

A

Bupropion.

36
Q

What is the onset of action like in most antidepressants?

A

Delayed - several weeks

37
Q

There is clearer evidence for the usefulness of antidepressants in what?

A

More severe depression  large placebo response in mild depression

38
Q

Who should you be cautious of the use of antidepressants in? Why?

A

Young adults/teenagers due to transient increase in suicidal/aggressive ideas

39
Q

What is lithium for bipolar normally given as?

A

Lithium carbonate

40
Q

Different forms of lithium have different bioavailability so be careful about doses if the type of lithium salt is changed

A

WARNING

41
Q

What must be monitored with lithium? Why?

A

12-hour post-dose blood levels.

- because of narrow therapeutic index.

42
Q

What are the common side effects of lithium?

A
  • Dry mouth / strange taste
  • Polydipsia & polyuria
  • Tremor
  • Hypothyroidism
  • Long term reduced renal function
  • Nephrogenic diabetes insipidus
  • Weight gain
43
Q

What are the toxic effects of lithium?

A
  • Vomiting
  • Diarrhoea
  • Ataxia / coarse tremor
  • Drowsiness
  • Convulsions
  • Coma
44
Q

Give examples of anticonvulsant drugs which can be used in long term treatment of BPAD.

A
  • Valproic acid.
  • Lamotrigine.
  • Carbamazepine
45
Q

What are the side-effects of carbamazepine?

A

Drowsiness, ataxia, cardiovascular effects, induces liver enzymes

46
Q

What is the main issue surrounding valproate?

A

Teratogenicity – neural tube defects

Therefore, don’t give to women of child-bearing age.

47
Q

Give 4 examples of antipsychotics that can be used as mood stabilisers.

A
  • Quetiapine.
  • Aripiprazole.
  • Olanzapine.
  • Lurasidone.
48
Q

What is the role of antipsychotics?

A

Dopamine + 5-HT antagonism

49
Q

What side effects may be associated with antipsychotics?

A
  • Sedation, weight gain, metabolic syndrome

* Extra-pyramidal side-effects (aripiprazole)

50
Q

What 5 things are involved in the serotonin pathway of the brain?

A
  • Mood
  • Sleep
  • Feeding
  • Behaviour
  • Sensory perception

Psychiatry (31 decks)

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